Bipolar Disorder
Changes in mood can sometimes come with noticeable changes in sleep, energy, thinking and behaviour. Understanding the pattern is an important first step towards getting appropriate care.
If you are concerned about yourself or someone close to you, you do not need to arrive with a diagnosis. Start by describing what has changed.
What is bipolar disorder?
Bipolar disorder is a mental health condition involving episodes of unusually elevated or irritable mood and increased energy, known as mania or hypomania. Many people also experience episodes of depression.
These episodes represent a significant change from the person’s usual state. They can affect judgement, relationships, work and everyday functioning. Some people have long periods of stability between episodes.
Bipolar disorder is more than ordinary changes in mood. Diagnosis depends on the pattern of symptoms over time – not a single behaviour or an online checklist.
Bipolar disorder at a glance
What changes
Mood, energy, sleep, activity and behaviour.
What matters
A distinct change from the person’s usual functioning.
Assessment
A psychiatrist reviews current symptoms and previous episodes.
Care
Treatment addresses both current symptoms and prevention of future episodes.
Recovery
Appropriate care can support a meaningful and productive life.
Types of bipolar disorder
Bipolar I disorder
Bipolar I disorder involves at least one manic episode. Depressive episodes are common, but a depressive episode is not required for this diagnosis.
Bipolar II disorder
Bipolar II disorder involves hypomanic episodes and major depressive episodes, without a history of mania. It should not be dismissed as a minor condition: depressive episodes can be severely disabling.
Cyclothymic disorder
Cyclothymic disorder involves a prolonged pattern of hypomanic and depressive symptoms that do not meet the full criteria for those episodes. Assessment considers their duration, persistence and effect on daily life.
Signs and symptoms of bipolar disorder
Unusually elevated or irritable mood
A person may feel unusually excited, confident or irritable. Family members may notice a marked change in temperament or behaviour.
Reduced need for sleep and increased energy
The person may sleep much less yet feel energetic, become unusually restless or take on many activities.
Changes in speech, thinking and attention
Speech may become rapid or difficult to interrupt. Thoughts may race, attention may shift quickly, and conversation can become difficult to follow.
Impulsive decisions and changes in judgement
Spending, sexual behaviour, plans or other decisions may become unusually impulsive or risky. The behaviour represents a change from the person’s usual judgement.
Depressive symptoms
Depression can involve persistent sadness, loss of enjoyment, low energy, disrupted sleep or appetite, poor concentration, hopelessness and withdrawal from others.
Psychotic symptoms
Severe episodes can involve hallucinations or delusions, such as hearing voices or holding strongly fixed beliefs that do not reflect reality. These symptoms require prompt assessment.
When should you seek professional help?
Arrange an assessment when changes in mood, sleep or behaviour are persistent, unusual for the person, or affecting daily life.
Seek prompt help if the person is becoming increasingly overactive, sleeping very little, making dangerous decisions, experiencing psychotic symptoms, or deteriorating despite treatment. Do not wait for a routine follow-up when safety is becoming a concern.
Urgent mental health help
Seek emergency help immediately if there is an immediate risk of suicide, serious self-harm or harm to another person, or the person cannot remain safe.
In India, call 112 or go to the nearest emergency department. Do not wait for a website appointment response.
If it is safe to do so, stay with the person while arranging help. Avoid confrontation and involve a trusted support person.
What can contribute to bipolar disorder?
There is no single known cause. Genetic vulnerability and other biological, psychological and social factors can contribute.
Stressful experiences, disrupted routines and alcohol or drug use may influence the course of the condition. Having a family history does not mean that someone will inevitably develop bipolar disorder.
How is bipolar disorder assessed?
Assessment looks beyond the person’s mood on the day of the appointment. Previous periods of increased energy or reduced sleep may be particularly important when someone seeks help for depression.
Your history over time
The psychiatrist asks about the severity, duration and pattern of symptoms, previous episodes and family history.
Physical health, medicines and substances
Physical examination or investigations may help identify other explanations. Thyroid conditions, some medicines and substance use can mimic or worsen mood symptoms.
Previous diagnoses and treatment
Earlier prescriptions, hospital records and treatment responses can help clarify the pattern. Diagnosis may require more than one appointment.
There is no single blood test or scan that establishes bipolar disorder.
What can you bring to the appointment?
Bring whatever is available; missing records should not prevent you from seeking help.
- Previous prescriptions and discharge summaries.
- A list of current medicines and supplements.
- Relevant investigation reports.
- A brief timeline of significant changes in mood, sleep and behaviour.
- Your main questions and treatment concerns.
You may also wish to bring someone you trust who can describe changes they have observed.
How is bipolar disorder treated?
Treatment is tailored to the current episode, previous response, physical health and individual preferences. Care usually combines medication with psychological and practical support.
The treatment needed during an episode may differ from the treatment used to maintain stability. Shared decisions should consider benefits, adverse effects and the person’s goals.
Treatment during mania or hypomania
Medication may be needed to reduce overactivity and stabilise mood. The clinician also assesses safety, sleep and whether care can be provided safely outside hospital.
Treatment during bipolar depression
Bipolar depression requires a treatment plan that accounts for the history of elevated mood. Antidepressants should not be started independently; their use requires specialist consideration because they can contribute to mood switching in some people
Longer-term medication
Medication may continue after symptoms improve to reduce recurrence. The choice depends on previous episodes, response, tolerability and health needs. Do not stop treatment simply because you feel well.
Psychological treatment
Structured therapy and psychoeducation can help people understand the illness, recognise early changes, develop coping strategies and manage difficulties in relationships and daily life.
When more intensive treatment is needed
Hospital care or specialist treatments may be considered when an episode is severe, safety is compromised or initial treatment is insufficient. The treating team should explain the reasons, options and monitoring involved.
Monitoring is part of treatment
The monitoring plan depends on the medication prescribed. It may include weight, blood pressure, blood glucose, cholesterol and medicine-specific blood tests.
Lithium requires blood-level monitoring and checks of kidney and thyroid function. Keep scheduled tests and discuss adverse effects with your clinician.
Important safety information for people taking lithium
Vomiting or diarrhoea alongside worsening shaking, confusion, unusual drowsiness, muscle weakness or difficulty speaking can indicate lithium toxicity.
If toxicity is suspected, stop taking lithium and seek emergency medical assessment immediately. Do not drive yourself.
Maintain adequate hydration, particularly in hot weather. Tell your doctor or pharmacist that you take lithium before starting another medicine, and avoid sudden changes in salt intake.
Pregnancy and planning a family
Discuss pregnancy plans with your psychiatrist before conception whenever possible. Medication and relapse-prevention plans may need adjustment.
Some medicines carry important reproductive risks. Valproate can cause serious harm to a developing baby and requires particular specialist attention.
If pregnancy occurs during treatment, contact your treating team promptly. Do not make abrupt medication changes yourself.
Bipolar disorder in children and adolescents
Young people require careful specialist assessment. Symptoms can overlap with ADHD, anxiety, depression and behavioural difficulties.
Assessment should consider development, school functioning, sleep and changes from the young person’s usual behaviour. Irritability or emotional outbursts alone do not establish bipolar disorder.
Treatment should involve the young person and appropriate family support, with ongoing monitoring of benefits and adverse effects.
Recovery and everyday life
Recovery includes returning to valued activities, rebuilding confidence and maintaining relationships – not only reducing symptoms.
Regular sleep, physical activity, manageable routines and supportive relationships can form part of ongoing care. Treatment should respect the person’s dignity and involve them in decisions.
Your follow-up planning checklist
Use appointments to agree on:
- Which changes should prompt an earlier review.
- Who to contact if symptoms return.
- What to do if medication causes problems.
- How to manage missed appointments or tests.
- What support may help with work, studies and family responsibilities.
Ask for the plan in writing if that would make it easier to follow.
Supporting someone with bipolar disorder
Prepare for the consultation
Write down concrete observations: changes in sleep, activity, spending, communication or everyday functioning. Note when they started.
Discuss how the person wants support
Ask whom they would like involved in appointments and what information they are comfortable sharing.
Agree on practical arrangements
Discuss appointment reminders, transport, record-keeping and emergency contacts. Bring disagreements or difficulties to the treating team rather than trying to resolve everything alone.
Make space for your own concerns
Family members can bring their own questions about communication, treatment and the impact of the condition on home life.
How Ahana Hospitals can help you take the next step
Whether you are seeking a first assessment or a review of ongoing treatment, contact Ahana Hospitals to discuss the appropriate appointment.
Tell the appointment team:
- Whether this is a first consultation or follow-up.
- Your preferred location.
- Any previous diagnosis or treatment.
- Whether you need assistance arranging the visit.
For immediate safety concerns, use emergency services rather than waiting for a routine appointment.
Frequently Asked Questions
Does feeling happy one day and sad the next mean bipolar disorder?
Not by itself. Assessment considers distinct episodes, accompanying changes in energy and behaviour, and their duration and impact.
Can hypomania be overlooked?
Yes. Someone may seek help for depression without recognising previous periods of increased energy as relevant. Mention these changes during assessment.
Can someone feel well between episodes?
Yes. Periods of stability can occur between episodes. Follow-up remains important even when symptoms have improved.
What if I am unsure about a previous diagnosis?
Bring your earlier records and explain your concerns. Ask the psychiatrist to review the history and the reasons for the diagnosis.
Can I bring a family member?
You can discuss this when arranging your appointment. Choose someone you trust and explain how you would like them involved.
Should I wait until I have all my old records?
No. Bring what you have and explain what is missing. Urgent symptoms should be assessed without waiting for paperwork.
Medically reviewed by
Dr. Vikhram Ramasubramanian
MD (General Medicine), MD (Psychiatry)
Consultant Psychiatrist, Ahana Hospitals
Clinical review: 11 September 2026
Next review: September 2027
This information is intended for general education and does not replace an individual assessment or professional medical advice.
Start with what has changed
You do not need to decide whether the problem is bipolar disorder before asking for help.
Describe the changes you have noticed and bring your questions. An assessment can help clarify the next steps.